Women of Size (yes, the ladies who started their pregnancy heavy)Women of Size often are told right off the bat that they will get diabetes, and end up with a cesarean--even before given the first exam! What a load of poppy-cock.When you are looking at studies, it's hard to figure out how caregiver bias has effected the outcomes. Don't assume that labor won't work for you.Women of Size, let's be up front about a few things.

Your OB/Midwife might not have experience with women of size and s/he might jump to conclusions. Hold their feet to the fire. You are entitled to the same quality of EVIDENCE BASED CARE as their tiny little mamas.

Yes, there is some extra skin and fat, so your OB/midwife might have to move some around to get a good heart beat. Help them, it's not a big deal.

There is no evidence that your uterus will explode should you want a vaginal delivery. (I'm just saying...)

The vaginal canal is not clogged up and your baby will get in position, just like all the other babies in all the other mommies.

Make sure your provider uses an extra large blood pressure cuff. A cuff that doesn't fit will give out the wrong reading. Same goes for tiny women, they need a child's cuff.

If your care provider shows a strong tendancy for bias against your weight, go ahead and find another provider who might be a better match.

It seems that it takes women of size longer to get to 6cm than smaller ladies. That means that you should be ready to give yourself extra time before agreeing to a "failure to progress" diagnosis.

Weight gain/loss may be different, depending on why you're sized the way you are. Sometimes women of size lose weight during a healthy pregnancy, and others gain. It's not the time to diet, but eating healthy (including enough calories to create a new human) is smart for all pregnant women.

Breast feeding is still the best for your baby. A good lactation consultant will help you find the right hold for you--just like she would for other moms.

I guess what I'm trying to say, is to please do not let the medical community assume you are anything other than the individual you are. Don't let them sign you up for more ultrasounds, non-stress tests, poking, proding, blood draws, prep you for an early cesarean, just because you carry more weight.You have the same responsibilities as other moms-to-be:

Eat healthy--this is not the time to diet.

Drink water.

Move your body--yoga, walking, and swimming are great for pregnant women.

Expand your mind--a good childbirth education class is a great way to prepare for birth and to know your options.

Hire a doula--Really, did you think I would leave this out?

Pick out cute baby clothes.

Try to stay calm while family members drag up all the scary birth stories that they heard about cousin Bob's ex girlfriend's Aunt Joan's co-worker's daugher's best friend.

Be assertive in telling anyone who wants to tell you a scary birth story to wait until next year to tell you. Take-a-way lessons are good (e.g. don't forget to wear a pad to the hospital in case your water breaks on the way over), but tell them to skip the scary stories.

Wear your own clothes. Buy something that may very well be a one use item, but BYO cute nightie and cover.

For any test or procedure, the same goes for you as goes for everyone else. Ask:

What is this test for?

How often is there a false positive or false negative? How accurate is it?

What happens if I don't do it?

What would I change depending on the results? If nothing, then why do it?

What are the risks to my baby?

Of course, you can always further your research on the internet. Look for medical sites (not just "I was fat and had a baby and I was fine" chit-chat). Look for research. Look for best practices. And don't forget (fat or thin): YOU CAN'T MEASURE WEIGHT BY BONE LEGNTH (this is about the ultrasound to guess weight at the end of the pregnancy).